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Sleep Disorders

Head feels like its going to explode or nose

01/09/2006

Question:

Sometimeswhen I am really tired and just about to fall asleep or I already asleep and think I`m awake, my head or my brain feels like it`s going to explode and I try to wake myself up but it takes me a little bit to wake up.And when I am trying to wake myself up,the feeling of my head exploding gets stronger til I wake up.Also,sometimes it feels like my nose is bleeding.Does this sound serious or do you think it`s all my imagination? It doesn`t happen all the time, just a few times,maybe once or twice a month or every couple of months.I hate it cause I`m afraid to go back to sleep.

Answer:

The symptom complex you are describing is quite interesting.  Based on the limited information you have provided, it is quite likely that you suffer from a condition known as, believe it or not, "exploding head syndrome."  This is an uncommon but well-described phenomenon that may present with many of the symptoms you are describing.

It is unclear just how common exploding head syndrome is, but there are only a handful of case descriptions in the medical literature.  This condition tends to affect women more than men and is most commonly seen around 50-60 years old, but may occur at any age.  Individuals who suffer from this condition typically describe a sensation of a sudden loud imagined noise (a "bang" or "clash of cymbals") or sense of a violent explosion in their head as they are falling asleep or waking during the night.  It is usually painless, though some have reported a stabbing sensation in the back of the head.  The attacks can be quite frightening, as you mention, as some individuals believe they are having a stroke.  The frequency of attacks can vary quite a bit, ranging from many on single night to only occurring every few months.  Often, the attacks occur when individuals are under stress or overtired.

The cause of exploding head syndrome is unknown.  Physiologic studies have been unable to find any clear abnormalities to explain the condition.  The good news is that the condition is considered benign, meaning that it is not harmful and there are no clear consequences to having the condition (other than the anxiety associated with it).  In addition, the symptoms frequently disappear over a period of time, usually in a few years.  Many individuals will experience a decrease in symptoms once they are reassured that the condition is not serious. There are a couple of case reports involving the use of the drugs clomipramine and nifedipine with some success.  Certainly, minimizing stress in your life and ensuring adequate sleep would be simple measures you could try.

There are other potential conditions that could explain your symptoms, though exploding head syndrome is the most likely diagnosis.  Other disorders that may mimic these symptoms include a number of different headache disorders ("ice-pick headaches," sleep-related migraines, cluster headaches, etc.), seizure disorders, panic attacks and nightmares.  You mention you have a sensation of feeling like your nose is bleeding with the episodes.  I am not aware of this symptom being related to exploding head syndrome and this may represent one of these other conditions or another phenomenon.

In order to confirm your diagnosis and exclude the other possibilities mentioned above, I recommend you discuss your symptoms with your primary care doctor.  It would be reasonable to have referred to a Sleep Specialist or a Neurologist to ensure further testing is not needed.

If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website.  In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.  Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University